Endoscopy-assisted surgery of the petrous apex

OBJECTIVE. Five large petrous apex lesions, 4 cholesterol granulomas and 1 cholesteatoma, were managed with a combination of microsurgical and endoscopic techniques. STUDY DESIGN AND SETTING: Retrospective review of clinical experience in an academic medical center. Traditional microsurgical approaches, infra-cochlear and/or retrofacial, were used in all cases, followed by endoscopic examination and debridement of the interior of the cysts. In all cases residual disease or fibrous septae within the cysts were found endoscopically that were not evident through use of the operating microscope. RESULTS: In all cases, the lesions were successfully managed without operative complications. CONCLUSIONS. The addition of endoscopic visualization to traditional microsurgical approaches allowed exposure of recesses within the lesions, removal of debris and inspissated secretions, and identification and removal of septae and fibrous bands within the petrous apex lesions that would not have been identified with the operating microscope alone. No surgical or postsurgical complications occurred in any of the cases, including facial weakness, hearing loss, or cerebrospinal fluid (CSF) leak.